Attachment 6 Specialized Experience Form.docx
DOCX document 19 KB Posted
- Attached to
- Big Bend Sewer Renovation Federal contract opportunity
- Solicitation number
- 75H70123R00068
About this file
This document is a specialized experience form required as part of a response to solicitation number 75H70123R00068 from the Department of Health and Human Services Indian Health Service for the Big Bend Sewer Renovation project. Respondents must provide details on at least two but no more than four relevant past projects as a prime contractor or subcontractor completed within the last six years, including project name and number, dates, value, location, description of scope and complexity, and references. Additionally, respondents must provide company information such as name, address, DUNS number, type of business including any applicable socioeconomic certifications, and a summary of core capabilities relevant to the statement of work.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| B05 Amendment 2.pdf | ||
| B05 Amendment 1.pdf | ||
| Attachment 5 Self Performed Calculation Sheet.docx | DOCX document | |
| Attachment 2 Specifications.pdf | ||
| Attachment 8 Past Performance Questionnaire.docx | DOCX document | |
| B01 23R00068.pdf | ||
| Attachment 7 Key Personnel Resume Form.docx | DOCX document | |
| Attachment 3 Drawings.pdf | ||
| Attachment 4 Project Location Map.pdf | ||
| Attachment 1 Wage Determination SD20230015.pdf |
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Text version
75H70123R00068 Big Bend Community Sewer Renovation Attachment 5
SPECIALIZED EXPERIENCE FORM
75H70123R00068 BIG BEND COMMUNITY SEWER RENOVATION
COMPANY INFORMATION
Company Name
Physical Address
SAM UEI Number
POINT OF CONTACT
Contact Name
Phone Number
Email Address
TYPE OF BUSINESS
Native American-owned (IEE/ISBEE), SBA certified 8(a), SBA Certified HUB Zone, Service Disabled Veteran-Owned Small Businesses (SDVOSB), Women Owned Small Business (WOSB), and/or Small Businesses (SB). For more information refer to http://www.sba.gov. IEE firms must submit Attachment 1: IHS IEE Representation Form (Jan 2022) along with the controlling enterprise’s Tribal enrollment/certificate of Degree of Indian Blood documentation
Type of Business?
COMPANY DESCRIPTION AND CORE CAPABILITIES
Summary description of the company, major services offered, and core capabilities related to the SOW of this project.
EXPERIENCE SUBMISSION
Requirements: Submit at least two (2) but no more than four (4) projects completed by your firm within the last six (6) years that are similar to the work that will be required under this project.
PROJECT 1
Project Name and Number
Prime or Subcontractor?
Dates of Construction
Contract Value
Contract Location
Contract Completion Date
Description of Scope Performed and Complexity (expand as needed)
Federal, State, Tribal, or Other?
Project Reference(s)/Agency Point of Contact (Title, Name, Phone, Email)
PROJECT 2
Project Name and Number
Prime or Subcontractor?
Dates of Construction
Contract Value
Contract Location
Contract Completion Date
Description of Scope Performed and Complexity (expand as needed)
PROJECT 3
Project Name and Number
Prime or Subcontractor?
Dates of Construction
Contract Value
Contract Location
Contract Completion Date
Description of Scope Performed and Complexity (expand as needed)
Federal, State, Tribal, or Other?
Project Reference(s)/Agency Point of Contact (Title, Name, Phone, Email)
PROJECT 4
Project Name and Number
Prime or Subcontractor?
Dates of Construction
Contract Value
Contract Location
Contract Completion Date
Description of Scope Performed and Complexity (expand as needed)
Federal, State, Tribal, or Other?
Project Reference(s)/Agency Point of Contact (Title, Name, Phone, Email)
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